Injuries to Muscles and Bones

1. Injuries to Muscles and Bones Lesson 14

2. Musculoskeletal System Review Bones Muscles Tendons Ligaments 

3. Primary Functions of Musculoskeletal System Provides shape/support for body Muscles acting on bones allow movement Bones protect vital internal organs 

4. Types of Muscles Skeletal muscles are voluntary Smooth muscles are involuntary Cardiac muscle is involuntary All muscle activity controlled by nervous system

5. Mechanisms of Injury to Musculoskeletal System Direct force: force applied directly to body Indirect force: force transferred from original body site along an extremity to another point Twisting forces: part of body forced to move in unnatural direction

6. Factors Involved in Injuries The greater the force: the more severe the injury fracture/joint dislocation more likely Patient�s age and health status

7. First Responders not responsible for determining type of musculoskeletal injury: Fractures Dislocations Sprains Muscle injuries Types of Musculoskeletal Injuries

8. Fractures The bone may be completely broken or only cracked Closed fracture - skin not broken Open fracture - open wound at site

9. Dislocations

10. Dislocations One or more bones at joint displaced from normal position Ligaments holding bone are torn Result from strong forces Sometimes accompanied by bone fractures or other injuries 

11. Dislocations continued Patient cannot use the joint due to pain/structural damage Serious bleeding may result Nearby nerves may be injured With severe dislocation, joint/limb will look deformed

12. Sprains Joint injury involving ligament stretching/tearing Typically occur when joint overextended Can be mild or severe Ankles, knees, wrists, fingers most common Considerable swelling often occurs rapidly

13. Muscle Injuries Strains, contusions, cramps Usually less serious than fractures/joint injuries Many causes

14. Recognizing Musculoskeletal Injury Sometimes injury type is obvious Often you will recognize musculoskeletal injury is present Emergency care is same regardless of injury type Usually not life threatening May be serious and result in pain/disability

15. Assessment of Musculoskeletal Injuries Perform standard assessment Ask patient what happened/what he/she felt If large forces involved, consider potential for spinal injury Expose injury site Amount of pain/swelling not indicator of injury severity Immediate medical treatment if no circulation/possible nerve damage

16. Assess for Circulation, Sensation, And Movement (CSM) Below the Injury Site Check pulse below injury Check skin color and temperature. Touch fingers/toes Does patient feel touch, tingling sensation, numbness. Have patient wiggle fingers/toes

17. Signs and Symptoms

18. Signs and Symptoms Abnormal sensation (numbness, tingling) Inability to move area Difference in temperature

19. Preventing Movement Movement causes injury, pain, swelling Bone movement further injures soft tissues Movement generally increases blood flow - may increase internal bleeding/ swelling Manually stabilize or splint injured area

20. Emergency Care of Musculoskeletal Injuries Perform standard patient care Control any life threats Allow patient to be in position of comfort Cover open wounds with sterile dressing Apply cold pack Don�t replace protruding bones

21. Emergency Care of Musculoskeletal Injuries Continued Stabilize injured extremity manually Support above and below injury If appropriate, splint extremity Follow local protocol re: oxygen

22. Splinting

23. Splinting Movement may worsen musculoskeletal injury and cause more pain Splint injured arm or leg if risk of area being moved (unless help expected quickly) Always splint an extremity before transporting victim

24. Splinting Helps prevent further injury Reduces pain Minimizes bleeding and swelling

25. Types of Splints Rigid splints Soft splints Air splints (inflatable splints) Pneumatic splints Anatomic splints 

26. Rigid Splint Board Plastic or metal Rolled newspaper or magazine Thick cardboard

27. Soft Splint Pillow Folded blanket or towel Triangular bandage folded into sling

28. Anatomic Splint Bandage injured leg or finger to uninjured one

29. Commercial Splints Many commercial splints are available

30. Securing Splints Use bandages, strips of cloth, Velcro� Use knots that can be untied Don�t secure with tape

31. Guidelines for All Splints Dress open wounds Splint only if it doesn�t cause more pain Splint in position found Immobilize entire area Pad between splint and skin

32. Guidelines for Slings Use sling to prevent movement and to elevate extremity Splint injury first If you splint injury in position found and this position makes use of sling difficult � do not use sling

33. Guidelines for Slings continued Do not move arm into position for sling if it causes pain A cold pack can be used inside sling Do not cover fingers inside sling

34. Skill: Applying Arm Sling and Swathe

36.

40. Shoulder Injuries Involve clavicle, scapula, or joint structures Clavicle is most frequently fractured bone Scapula fractures are rare Shoulder dislocations are common

41. Splinting Shoulder Injuries Goal is to stabilize area from trunk to upper arm Use soft splint. Do not move extremity Assess for circulation, sensation, and movement

42. Shoulder Injuries Pad hollow between body and arm Apply sling and binder to support and immobilize arm if this causes pain use larger soft splint

43. Upper Arm Injuries Immobilize humerus fractures with rigid splint Treat fractures near shoulder with soft splint

44. Splinting Upper Arm Injuries Stabilize bone between shoulder and elbow Assess circulation, sensation, movement in hand/fingers Apply rigid splint along outside of arm

45. Splinting Upper Arm Injuries continued Tie above injury and at elbow Support wrist with sling and wide swathe If it causes pain to raise wrist for a sling, use long rigid splint

46. Elbow Injuries Sprains and dislocations are common Fractures occur above or below elbow Patient unable to move joint 

47. Splinting Elbow Injuries If elbow bent, apply rigid splint from upper arm to wrist If more support needed, use sling at wrist and binder around chest

48. Splinting Elbow Injuries If elbow straight, apply rigid splint from upper arm to hand If more support needed, use binders around chest and upper arm and lower arm and waist

49. Skill: Splinting a Forearm

54. Wrist Injuries Sprains Fractures

55. Splinting Wrist Injuries Goal is to stabilize from forearm to hand Soft splint and sling often sufficient Rigid splint provides more support Assess circulation, sensation, movement in hand and fingers

56. Wrist Injuries Apply rigid splint on palm side of arm from forearm past fingertips Tie above and below wrist Leave fingers uncovered Support forearm and wrist with sling and apply binder around upper arm and chest

57. Hand Injuries May be injured by direct blow Fractures occur when patient punches something with closed fist

58. Splinting Hand Injuries Goal is immobilization of hand Use soft or rigid splint Place roll of gauze in palm Bandage entire hand Place rigid splint on palm side of hand. Pad between hand and splint Support further with sling and swathe 

59. Finger Injuries Fractures and dislocations Often splint not required Use rigid splint or anatomic splint

60. Splinting Finger Injuries Use soft splint if finger cannot be straightened without pain Don�t manipulate finger into normal position Use rigid splint, secured with tape Tape finger to adjoining finger with gauze in between

61. Lower Extremity Injuries Larger forces are typically involved Forces may also cause spinal injury Assess patient, without moving extremity Femur fracture can damage femoral artery 

62. Hip and Pelvis Injuries Fractures and dislocations A hip fracture = fracture of top part of femur Fractures more common in elderly Bleeding and pain may be severe Dislocations occur at any age Falls Vehicular crashes Blows to body 

63. Hip Injuries Do not move patient Immobilize leg and hip in position found Pad between legs and bandage together (unless this causes more pain) Treat for shock but do not elevate legs

64. Upper Leg Injuries Femur fractures serious Severe pain/shock may occur Keep patient from moving Use rigid splint if lying down with leg supported by ground Use folded blankets/coats to immobilize leg in position found

65. Splinting Upper Leg Injuries Anatomic splint Rigid splints

66. Splinting Upper Leg Injuries continued Check circulation and sensation in foot and toes Put rigid splint on each side of leg Pad body areas and voids Inside splint should extend from groin past foot Outside splint should extend from armpit past foot

67. Traction Splint for Femur Fractures Traction splint maintains continual pull on femur to keep bone ends in normal position First Responders usually assist other EMS personnel

68. Knee Injuries Sprains Dislocations Caused by sports injuries, motor vehicle crashes, falls Femur, tibia or fibula fractures indistinguishable from knee injuries

69. Splinting Knee Injuries Splint in position found Apply soft splint by rolling blanket or placing pillow around knee If knee straight, make anatomical splint

70. Splinting the Knee If possible, put rigid splint on both sides of leg Pad body areas and voids Check circulation and sensation in foot and toes first and periodically after splinting

71. Splinting the Knee If knee is straight apply two splints along both sides of knee If knee is bent, splint in position found Tie splints with cravats or bandages

72. Lower Leg Injuries Many causes Either or both bones of lower leg can be fractured

73. Lower Leg Injuries Rigid splint applied the same as for knee injury Three-sided cardboard splint can be used

74. Skill: Splinting the Leg (Anatomic)

79. Ankle Injuries Commonly a sprain occurring when foot forcefully twisted to one side Fractures or dislocations Often involve torn ligaments and nerve/blood vessel damage 

80. Splinting Ankle Injuries Soft splint usually best Assess circulation, sensation, movement in toes

81. Foot Injuries Commonly caused by direct blows/falls Involve almost any bone/ligament of foot Treat same as ankle injuries Toe fractures can be very painful

82. Splinting Foot Injuries Usually no splinting required Use pillow splint as for ankle injury if: toe is significantly bent more than one toe involved foot is very painful

83. Rib Fractures Typically caused by blunt trauma to chest More common in lower ribs and along side Cause severe pain, discoloration, swelling Pain often sharper upon breathing in Patient may breathe shallowly and hold/support area

84. Splinting Rib Injuries Goal is primarily supportive Have patient sit/stand in easy breathing position Support ribs with pillow or soft padding loosely bandaged over area and under arm Immobilize arm with sling and swathe Monitor breathing